Comparison of Clinical Outcomes of Early and Late Tracheostomy

Kang, Won Yu; Im, Jong Cheol; Park, Chang Min; Cho, Sang Cheol; Jung, An Dok; Cho, Yong Chan; Ki, Young Hwa; Lee, Bong Gyu; Rheu, Hyung Seon; Kim, Wan

Abstract

Tracheostomy has been performed in whom prolonged mechanical ventilation is needed. Recent advancement of skillful tracheostomy reduced it's complications and shortened the duration from intubation to tracheostomy. Purpose of this study was to determine whether early tracheostomy in critically ill patients reduces days of ventilatory support, hospital length of stay, incidence of pneumonia, length of stay in ICU (intensive care unit), and mortality. All consecutive 56 patients undergoing tracheostomy from Jan. 2003 to Jun. 2005 were analyzed. The patients were divided into two groups: 23 performed tracheostomy within 7 days after endotracheal intubation (Group I, 70.5+/-7.92 years, 82.6% male) and 33 performed tracheostomy after 7 days (Group II, 67.3+/-11.36 years, 90.9% male). Outcome data (days of ventilatory support, incidence of pneumonia, ICU length of stay, mortality) were evaluated. Baseline clinical characteristics were not different between the two groups. Ventilators were applied 34.8% in group I and 75.8% in group II (p value=0.002). There was no significant difference between the two groups in days of ventilatory support, hospital length of stay. Incidence of pneumonia (p-value=0.041), length of stay in ICU (p-value=0.026), mortality in 6 months (p-value=0.014) were significantly lower in group I. But, there was no significant difference in these outcomes between the two sub-groups, which were made up of patients applied mechanical ventilators in each group. We performed partial correlation test between tracheostomy time and outcomes controlling for mechanical ventilation. Positive correlation was observed between tracheostomy time and length of stay in ICU (r=0.522, p-value=0.013). Early tracheostomy had benefit over late tracheostomy in reducing length of stay in ICU. The large scale and prospective studies may be needed to confirm our study.